Carissa Anne Fuller, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

12043 Issued in MN

Practice address

1175 Nininger Rd
Hastings, MN 55033-1056

Phone

(651) 480-4100

NPI assigned

May 11, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Allina Health System

  • Family Medicine Physician
  • Minneapolis, MN
  • NPI 1467758813
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1652227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652227200000",
    "number": "1013653955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11053 287TH AVE NW",
            "city": "ZIMMERMAN",
            "state": "MN",
            "postal_code": "553984344",
            "telephone_number": "612-220-6509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1175 NININGER RD",
            "city": "HASTINGS",
            "state": "MN",
            "postal_code": "550331056",
            "telephone_number": "651-480-4100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8100 Medicine Lake Rd",
            "address_purpose": "LOCATION",
            "city": "New Hope",
            "state": "MN",
            "postal_code": "554273404",
            "country_code": "US",
            "telephone_number": "800-385-2527",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FULLER",
        "first_name": "CARISSA",
        "middle_name": "ANNE",
        "name_prefix": "Dr.",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-11",
        "last_updated": "2022-05-11",
        "certification_date": "2022-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "12043",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Flom
• Dustin Fore, PSYD
• Jeffrey John Fox, DDS
• Katie Freeman
• Karyl Leanne Frye, M.S., LMFT
• Jolynn M Ganther, LMT
• Joshua Ray Geidel, D.C.
• Christine Elizabeth Gendreau, LAC
• Joan Gilbertson, RPH
• Kristen M Gilleo, FNP

• Physical Therapist in Hastings, MN
• Providers in Hastings, MN by specialty
• Physical Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.